Sažetak
Uvod/Cilj. Kod imunotrombotskih poremećaja kao što je bolest izazvana korona virusom 2019 (coronavirus disease 2019–COVID-19), nivoi D-dimera često su povišeni, što odražava povećano stvaranje i razgradnju fibrina. Dodatni biomarkeri, kao što su odnos neutrofila i limfocita (neutrophil-to-lymphocyte ratio – NLR) i nivoi C-reaktivnog proteina (CRP) i laktat dehidrogenaze (LDH), povezani su sa težinom i ishodima bolesti. Cilj rada bio je da se proceni uticaj dva različita antikoagulaciona protokola na nivoe biomarkera D-dimer, NLR, CRP i LDH u serumu, kao i njihova prognostička vrednost u pogledu kliničkih ishoda kod kritično obolelih od COVID-19. Metode. Retrospektivnom studijom obuhvaćeni su kritično oboleli od COVID-19, primljeni na Odeljenje intenzivne nege u periodu od aprila 2020. do decembra 2021. godine i upoređeni su protokoli za vođenje antikoagulantne terapije pomoću D-dimera i pomoću anti-Xa inhibitora. Bolesnici su prema režimu antikoagulantne terapije bili podeljeni u dve grupe: grupu u kojoj je primenjen protokol vođen anti-Xa vrednostima (AXa grupa – A-XaG) i grupu gde je primenjen protokol sa doziranjem prema D-dimer vrednostima (D-d grupa – D-dG). Rezultati. Analizirano je ukupno 395 bolesnika: 137 u A-XaG i 258 u D-dG. Vrednosti CRP, LDH i D-dimera bile su značajno niže u A-XaG u odnosu na D-dG (p < 0,001, p < 0,001, p = 0,001, redom). Univarijantnom analizom su kao prognostički faktori mortaliteta pokazani životno doba [odds ratio (OR): 1,064; p < 0,001)], LDH (OR: 1,002; p < 0,001), CRP (OR: 1,005; p < 0,001) i D-dimer (OR: 1,054; p = 0,020). Analizom multivarijantnog modela pokazano je da su samo životno doba > 64 godine (OR: 10,215; p < 0,001) i LDH > 395 U/L (OR: 5,491; p = 0,005) ostali nezavisno povezani sa smrtnim ishodom. Zaključak. Antikoagulantna terapija vođena anti-Xa vrednostima bila je povezana sa nižim vrednostima inflamacijskih biomarkera kod obolelih od COVID-19 na Odeljenju intenzivne nege. Iako su univarijantnom analizom kao potencijalni prognostički faktori mortaliteta identifikovani životno doba, LDH, CRP i D-dimer, samo su životno doba i LDH ostali statistički značajni pokazatelji u multivarijantnom modelu, što ukazuje na nezavisnu prognostičku vrednost kod te populacije bolesnika.
Ključne reči
biomarkeri;
covid-19;
faktor xa;
heparin;
intenzivna nega, odeljenja;
prognoza
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